The Scalable PArtnering Network for CER: Across Lifespan, Conditions, and Settings, or SPAN, will develop a distributed research network that is interoperable across a range of health care systems and sites, incorporating large and diverse patient populations. The network infrastructure will have the capability to conduct large comparative effectiveness research (CER) studies using data collected on patient-reported outcomes collected at the point of care and real-time data collection. Furthermore, we address the important issue of governance to oversee all aspects of managing and conducting research with confidential health information. SPAN will leverage previous AHRQ support of the development of the DEcIDE Distributed Research Network to create the expanded and enhanced network suitable for conducting comparative effectiveness research (CER), compatible with AHRQ's mission to improve the quality and effectiveness of health care. One particularly unique feature of the SPAN network is the incorporation of integrated and less-integrated (community) health systems-an addition that poses potential data management challenges that are vastly outweighed by the benefits of adding diverse patient populations to distributed research networks. If this pilot effort on expanding across types of health systems is successful, we would propose future expansion of this feature. We selected initial cohorts for development that not only present opportunities for comparative effectiveness studies of treatments and processes of care, but that lend themselves to expansion for further cohort development-across AHRQ priority conditions and populations, different sites, and increased complexity of descriptive and treatment variables. Thus, the current proposal sets the stage for significant future CER by developing a network with the capacity to extract diagnostic, treatment, descriptive, and process of care data on more than 7.3 million individuals, the ability to grow and diversify, and the governance infrastructure to proactively address the complex issues that inevitably accompany investigations dependent on healthcare data. Results from research conducted with cohorts derived from this network will inform care delivery on individual levels as well as policy- level decisions on healthcare funding and reform. PUBLIC HEALTH RELEVANCE: The SPAN network will help researchers and public health officials study a broad spectrum of treatments, for multiple health conditions, in diverse patient populations, and across multiple types of health care systems. Findings will inform evidence-based health care and improve the national allocation of health care resources.